Child death review system suffers from lack of funding

Washington’s once prestigious child death review system, which state health officials say helps them identify ways to prevent the future deaths of children, has declined in recent years because of lack of funding by the Washington Legislature.

Though many jurisdictions, such as the Spokane Regional Health District, have assumed the entire cost of reviewing unexpected child deaths, nearly half do not.

In the nearly six years it was funded by the Legislature, the system investigated the unexpected deaths of more than 1,600 children through 17 years of age and helped launch injury and disease prevention campaigns and policy changes aimed at saving young lives.

From 1997 through June 2003, the state built a child death review system encompassing every health district in Washington, which became the envy of most other states.

The annual cost was about $500,000. Funding was lost in the 2003-05 budget battle and has not resumed.

“If preventing childhood deaths isn’t a priority, I would question the validity of what they are doing over there in Olympia,” said Dr. John Howard, Spokane County medical examiner, a member of the local death review team.

The vast majority of child death review team members are volunteers, Howard said. They include personnel from police, fire and public health departments, prosecutors’ offices, the state children’s administration and coroners or medical examiners.

These review teams are separate from the committees convened by the state Department of Social and Health Services when a child dies within a year of receiving state social services.

The job of the teams is to collect data that show fatality trends and to help find ways to prevent such trends from continuing. About 250 child deaths each year are categorized as unexpected – 35 percent of total child deaths in Washington.

Reviews of these deaths have resulted in local campaigns to prevent crib deaths of infants, water safety and bicycle helmet laws, removal of unsafe toys and child products and better crime scene investigations. Most recently in Spokane County, the reviews have detected an increase in fatal vehicle accidents involving teens and alcohol.

But though state law authorizes local health departments to conduct such reviews, it does not require them to, nor does it provide funding. Today only about 17 of the 30 original teams are still in operation.

“Administrators decided the project was not a priority to them,” said Deborah Robinson, an infant death specialist with the Northwest Infant Survival Alliance-SIDS Foundation of Washington.

Those involved in preventing sudden infant death syndrome “rely on the data and oversight of child death review,” said Robinson, of Seattle. “Unless we study how they died, we will never understand how to keep them alive. It is critical that our state get back on board.”

This year, her foundation convinced the Legislature to provide a one-time appropriation of $100,000 for the program, money that will probably go toward training at the state Department of Health. Robinson said that’s not enough.

“We would like line-item funding specifically for child death review with committee oversight,” she said. “Children are owed this process and we need to figure out how to make it work.”

Those health jurisdictions that continue to maintain child death review teams have done so by absorbing the costs into their general funds.

“It has been a constant struggle for these teams, and they are continuously having to reevaluate their priorities,” said Diane Pilkey a Washington State Department of Health epidemiologist who coordinates child death reviews.

When every county was involved in the reviews, Pilkey said, “We could look at statewide data. Now we are missing a lot of important information about what is happening with our kids who are dying, and missing opportunities to have a comprehensive statewide picture of child death.”

In 2002, the last full year of state funding, the Spokane Regional Health District received $29,000 for child death reviews, according to Lyndia Tye, director of disease prevention and response for the district. To that the district added $15,000 out of its general fund.

In recent years, the district has absorbed the entire cost of maintaining a child death review team, said Elaine Conley, the district’s director of community and family services. This includes about 15 hours a month of a public health nurse’s time to prepare records for the team to review, and about 20 hours a month of an administrative assistant’s time to collect and enter data into a database.

“It’s important work to be done and if it were better funded, we could certainly be more assertive in developing campaigns based on information coming out of child death review committee,” Conley said.

The district’s former health officer, Dr. Kim Thorburn, described child death review as a “worthwhile endeavor,” particularly if it results in some action to prevent future deaths, such as public health campaigns.

“Campaigns are the really costly part, and there was never any funding for this,” she said.